非甾体抗炎药引起胃十二指肠溃疡的相关危险因素

M Michael Wolfe
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引用次数: 0

摘要

非甾体抗炎药(NSAIDs)对胃肠道粘膜损伤的风险是剂量依赖性的。流行病学研究清楚地表明,常用的非甾体抗炎药发生溃疡并发症的风险按等级排序,布洛芬的风险最低,吡罗西康的风险最高。抗酸剂、H2受体拮抗剂和米索前列醇作为预防药物都有缺点。在环加氧酶(COX)-2选择性非甾体抗炎药中,罗非昔布与胃肠道毒性风险较低相关,但与塞来昔布相关的长期风险尚不确定。罗非昔布与心肌梗死的发生率明显高于萘普生,这可能抵消了其更大的胃肠道安全性的益处。在非处方剂量下,与长期使用规定剂量相比,使用时间短和剂量低降低了严重不良事件的风险。低剂量非甾体抗炎药的间歇性治疗已被证明是非常安全的,并且尚未确定COX-2选择性药物与此类治疗相比是否具有安全性优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk factors associated with the development of gastroduodenal ulcers due to the use of NSAIDs.

The risk of gastrointestinal mucosal injury with non-steroidal anti-inflammatory drugs (NSAIDs) is dose-dependent. Epidemiological studies have clearly demonstrated a rank order of risk of ulcer complications for commonly used NSAIDs, with ibuprofen consistently associated with the lowest risk and piroxicam with the highest. Antacids, H2 receptor antagonists and misoprostol all have drawbacks as prophylaxis. Of the cyclo-oxygenase (COX)-2 selective NSAIDs, rofecoxib is associated with a lower risk of gastrointestinal toxicity but there is uncertainty about the long-term risk associated with celecoxib. Rofecoxib has been associated with a significantly higher incidence of myocardial infarction than naproxen that may counteract the benefit of greater gastrointestinal safety. At over-the-counter doses, the short duration of use and the low dose reduce the risk of a serious adverse event compared with chronic use at prescribed doses. Intermittent therapy with low-dose NSAIDs has proved extremely safe and it has not been determined whether COX-2 selective agents offer a safety advantage compared with such treatment.

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